House Republicans were all smiles while celebrating the passage of the American Health Care Act with President Trump last month, but GOP senators did not appear jubilant. The bill was only popular with people who spent their frat days dreaming of cutting Medicaid, and some members of Congress even admitted that they only voted for it because they knew the Senate would make significant changes. “Is this bill good? No, I don’t like it,” said Representative Mario Diaz-Balart.
The health bill was always going to be more difficult to pass in the Senate. With 52 Republican senators and no Democratic support, the GOP can only afford to lose two votes. Plus, for months, a handful of far-right senators have demanded a bill that thoroughly demolishes Obamacare, while more moderate Republicans insisted that they won’t vote for legislation that takes health care away from the millions of newly insured Americans. By passing AHCA, the House asked the Senate to come up with a way to get around these fundamental divisions in the Republican vision for the U.S. health-care system (and whatever they come up with still has to make it through round two in the House).
Top GOP senators said their party should proceed with caution, and engage in long deliberations. Instead, Senate Majority Leader Mitch McConnell spent the past two months crafting a new GOP health bill in secret. He plans to release the details on Thursday morning, and hold a vote next week.
McConnell is an incredibly gifted political strategist, but on Wednesday Republicans didn’t seem to have much faith that he had come up with a crowd-pleasing plan to revamp one-sixth of the economy.
Democrats have hammered McConnell on the hypocrisy of ramming through a secret health bill after complaining about the more than yearlong negotiation and review process that led to the passage of Obamacare. But even Republican senators are grumbling that McConnell is being too secretive. “The whole process is not satisfactory,” said Senator John McCain. “I feel terrible about it.”
According to the Washington Post, in briefings McConnell’s office has only offered senators a hazy picture of the bill. Incredibly, Senator Mike Lee, who’s part of the small group of lawmakers crafting the bill, claimed that he does not know what’s in it.
“It’s not being written by us,” he said during a Facebook Live event on Tuesday. “It’s apparently been written by a small handful of staffers in the Republican leadership in the Senate.”
The details that leaked on Wednesday evening do not suggest that McConnell is preparing to surprise his conference with a bill that magically resolves the divisions within the GOP. The Senate version of the bill is said to provide subsidies for buying insurance on the exchanges based on income, like Obamacare, rather than age, like the House bill. But many people will still lose coverage under the Senate bill because it lowers the income cutoff for receiving those subsidies. The Senate bill is also expected to take longer to phase out Obamacare’s Medicaid expansion, but it would eventually implement even deeper cuts to the program for low-income Americans than the House bill.
Most senators were not involved in hashing out these compromises, and The Wall Street Journal reports that both centrist and conservative Republicans feel that they’re getting the short end of the stick.
Despite nods to the most conservative senators, such as the bill’s anticipated loosening of Obamacare’s essential health benefits, on Wednesday Senator Rand Paul said it still sounded like “Obamacare-lite” and said the subsidies were too generous.
“If our bill comes in with greater subsidies than Obamacare, I think it’s going to be harder for conservatives to support,” he told Politico. “That, to me, is really a nonstarter.”
Meanwhile, rather than getting excited about the prospect of a bill that keeps some of Obamacare’s protections for people with preexisting conditions, Senator Susan Collins, a moderate, seemed focused on the fact that millions are likely to lose their coverage.
“The president has argued for a more generous bill,” she said. “We’ll have to see what comes out tomorrow, but I’m wondering if those who are drafting the bill are listening to what the president said about the need for the bill to be more generous.”
Another possible reason for the lack of enthusiasm: It’s unlikely that whatever McConnell unveils will be what’s voted on next week. Senators will have an opportunity to introduce amendments to the bill, and there are many thorny issues that still need to be settled, like whether the House bill’s prohibition on using tax credits to purchase health plans that cover abortion must be dropped due to complicated Senate rules.
Some Republicans say there’s no way they can process whatever framework McConnell’s produced and hash out all of their remaining disagreements in just a matter of days.
“I would find it hard to believe I will have enough time,” Senator Ron Johnson said. “I’ve made leadership well aware of the fact that I need information to make a final decision, and if I don’t have the information to justify a yes vote, I won’t be voting yes.”